Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis.

Journal article

An open, paired, randomized, controlled trial of high-dose parenteral ceftazidime (120 mg/[kg.d]) vs. amoxicillin/clavulanate (160 mg/[kg.d]) for the treatment of severe melioidosis was conducted in Ubon Ratchatani in northeastern Thailand. Of 379 patients enrolled in the study, 212 (56%) had culture-proven melioidosis; 106 patients were in each treatment group. The overall mortality rate (47%) was similar for both treatment groups. However, 4 of 75 surviving patients in the ceftazidime group compared with 16 of 69 surviving patients in the amoxicillin/clavulanate group were switched to the alternate regimen because of an unsatisfactory clinical response after > or = 72 hours of treatment (P = .004). The overall therapeutic failure rate (i.e., treatment failure or death due to uncontrolled melioidosis) was significantly higher for the amoxicillin/clavulanate group than for the ceftazidime group (P = .02). Clinical and bacteriologic responses for successfully treated patients were similar in both groups, and both treatments were well tolerated. Parenteral amoxicillin/clavulanate is a safe and effective initial treatment, but parenteral ceftazidime remains the treatment of choice for severe melioidosis.

Authors: Suputtamongkol, Y; Rajchanuwong, A; Chaowagul, W; Dance, D; Smith, MD

• Publication status: Published
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
• Volume: 19
• Issue: 5
• Pages: 846-853
• Publication date: 1994-11-01
• DOI: 10.1093/clinids/19.5.846
• EISSN: 1537-6591
• ISSN: 1058-4838
• Language: English
• Keywords: Amoxicillin-Potassium Clavulanate Combination; Melioidosis; Clavulanic Acids; Aged; Adult; Female; Ceftazidime; Drug Therapy, Combination; Aged, 80 and over; Middle Aged; Pseudomonas aeruginosa; Male; Treatment Failure; Adolescent; Humans; Amoxicillin